Question 1

The gate control theory of pain transmission predicts that activity in touch receptors will&#10;A) enhance perception of pain.&#10;B) decrease pain signal transmission in the spinal cord.&#10;C) activate opioid receptors in the CNS.&#10;D) increase secretion of substance P in the spinal cord.

Accepted Answer

The gate control theory is used to explain how stimulation of large "touch" neurons could inhibit the transmission of nociceptor impulses.Central to the gate control theory is the capacity for interneurons in the spinal cord to modify the transmission of nociceptor impulses.The gate control theory is not based on a theory that activity in touch receptors will enhance perception of pain.Opioid receptors are thought to be the mediators of presynaptic inhibition.One way to inhibit synaptic transmission is through presynaptic inhibition of substance P release from nociceptor neurons.

Question 2

Most sensory afferent pain fibers enter the spinal cord by way of the ________ nerve roots.&#10;A) anterior&#10;B) posterior&#10;C) C fiber&#10;D) anterolateral

Accepted Answer

Most sensory afferent pain fibers enter the spinal cord by way of the posterior nerve roots.The cell bodies of pain neurons are located in the dorsal root ganglion.Sensory afferent pain fibers do not enter the spinal cord by way of anterior nerve roots.Pain transmitted by C fibers is poorly localized and transmitted slowly.Many neurons originating in lamina I cross the spinal cord to activate neurons in the anterolateral tract.

Question 3

Referred pain may be perceived at some distance from the area of tissue injury,but generally felt&#10;A) on the same side of the body.&#10;B) with slightly less intensity.&#10;C) within the same dermatome.&#10;D) within 10 to 15 cm area.

Accepted Answer

Referred pain is perceived in an area other than the site of the injury.It is often felt at some distance from the point of nociceptor activation.Pain is generally referred to other structures in the same sensory dermatome.The brain cannot differentiate the two sources of pain signals and tends to attribute the visceral pain to a body surface location regardless of on which side of the body the injury occurs and on which side of the body the referred pain is felt.Referred pain is not felt with less intensity.Referred pain is not perceived at a distance that is within 10 to 15 cm.

Question 4

Which treatment is helpful in neuropathic pain but not used for acute pain?&#10;A) Narcotic analgesics&#10;B) Nonsteroidal anti-inflammatory drugs and aspirin&#10;C) Anticonvulsants&#10;D) Nonnarcotic analgesics

Accepted Answer

Management of pain associated with neuralgia includes antiseizure medications.Narcotic analgesics are discouraged for long-term therapy.NSAIDs and aspirin are not indicated for treatment of neuropathic pain.Management of neuralgia includes topical and systemic therapies.

Question 5

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to&#10;A) neuralgia.&#10;B) intermittent claudication.&#10;C) fibromyalgia syndrome.&#10;D) neuropathy.

Accepted Answer

Patients complain of pain that waxes and wanes and that does not follow a dermatomal pattern in fibromyalgia syndrome.The pain tends to be exacerbated by physical exertion.Trigeminal neuralgia is a form of neuropathic pain that can be quite disabling for patients.It is sudden,momentary,but excruciating pains along the second and third divisions of the trigeminal nerve.In the early stages,intermittent claudication is associated with physical activity and alleviated with rest and has a cramping quality.In severe cases,ischemic neuropathy may ensue and cause a more consistent burning,shooting pain in the leg or foot.In pain related to neuropathy,patients complain of burning pain in the distal bilateral lower extremities that is frequently worse at night.

Question 6

One of the most common causes of acute pain is&#10;A) headache.&#10;B) fibromyalgia.&#10;C) malignancy.&#10;D) trigeminal neuralgia.

Accepted Answer

Headache is one of the most common causes of acute pain,accounting for approximately 13 million visits each year in the Unites States to physician's offices,urgent care clinics,and emergency departments.Fibromyalgia syndrome is a chronic pain syndrome.Cancer pain is a subcategory of chronic pain,although it may be acute.Trigeminal neuralgia is a form of neuropathic pain.

Question 7

A patient presenting with a severe,pounding headache accompanied by nausea and photophobia is likely experiencing a ________ headache.&#10;A) tension&#10;B) migraine&#10;C) sinus&#10;D) chronic

Accepted Answer

Typical signs of a migraine headache include severe unilateral pounding or throbbing pain that may be accompanied by nausea,vomiting,photophobia,phonophobia,and lacrimation.A severe,pounding headache with nausea and photophobia is likely to be a migraine headache.A sinus headache is not typically associated with nausea and photophobia.Pain is considered chronic when it lasts more than several months beyond the expected healing time.

Question 8

It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for&#10;A) education.&#10;B) stimulation.&#10;C) intervention.&#10;D) documentation.

Accepted Answer

It is clinically useful to conceptualize pain physiology according to these four processes,because each stage provides an opportunity for intervention in the pain experience.It is more useful to provide intervention for the patient experiencing pain.Stimulation may actually increase the pain level for the patient.Documentation of findings is appropriate,but taking measures to reduce or stop the pain is more advantageous.

Question 9

Modulation of pain signals is thought to be mediated by the release of&#10;A) histamine.&#10;B) endorphins.&#10;C) cholecystokinin.&#10;D) glutamine.

Accepted Answer

Pain modulation occurs not only at the cord level but also in the brain itself.Opioids such as endorphins produced in the brain are thought to be important modulators of pain perception.Histamine is a chemical mediator of pain which is involved in the transduction phase.Cholecystokinin is a substance involved in synaptic transmission in the spinal cord.The excitatory neurotransmitter glutamate is involved in carrying the nociceptive message from primary afferent fibers to secondary neurons.

Question 10

Slow pain sensation is transmitted primarily by&#10;A) group Ia afferents.&#10;B) a motor neurons.&#10;C) unmyelinated C fibers.&#10;D) Ad fibers.

Accepted Answer

The majority of pain sensations travel via C fibers and project to areas of the brain that evoke emotional responses such as displeasure and anxiety.Unmyelinated C fibers transmit pain more slowly.Pain transmitted by C fibers is poorly localized and has a dull or aching quality that lingers long after the initial sharp pain abates.Group Ia afferents are not the source of slow pain sensation.Slow pain sensation is not transmitted by a motor neurons.The nature of the pain carried by the fast-traveling Ad fibers is characterized as sharp,stinging,and highly localized.

Question 11

Pain is thought of as&#10;A) a subjective experience that is difficult to measure objectively.&#10;B) associated with changes in vital signs reflecting its intensity.&#10;C) experienced in the same way by all individuals.&#10;D) always the result of tissue damage that activates nociceptors.

Accepted Answer

The answer of Pain is thought of as&#10;A) a subjective...

Question 12

The ________ is the level of painful stimulation required to be perceived.&#10;A) perception&#10;B) tolerance&#10;C) expression&#10;D) threshold

Accepted Answer

The answer of The ________ is the level of painful...

Question 13

The physiologic mechanisms involved in the pain phenomenon are termed&#10;A) nociception.&#10;B) sensitization.&#10;C) neurotransmission.&#10;D) proprioception.

Accepted Answer

The answer of The physiologic mechanisms involved in the pain...

Deck 47: Pain